| PartⅠAnalysis of risk factors and construction of a predictive model for perioperative ischemic complications of endovascular treatment in ruptured anterior communicating aneurysmsObjective: To investigate the potential risk factors for perioperative ischaemic complication(PIC)of endovascular treatment(EVT)for ruptured anterior communicating artery aneurysms(ACo AAs).And to establish and validate a risk prediction model for the risk of perioperative ischaemic complications in these patients.Methods: The general clinical,status on admission and morphological data,operation schemes,and treatment outcomes of patients with ruptured ACo AAs treated with EVT in the First Affiliated Hospital of Dalian Medical University from January 2010 to January 2021 were retrospectively analyzed and were randomized in an 8:2 ratio into a training(340 patients)and validation(86 patients)cohorts.The independent variables of the training cohort were first screened using LASSO regression,followed by multivariate logistic regression analysis to build a predictive model.The discrimination ability,calibration accuracy and clinical utility of the established perioperative ischaemic complications risk prediction model were evaluated and verified based on the receiver operating characteristic curves,calibration curves and decision curve analysis in the training and external validation cohorts,respectively.Results: A total of 426 patients were included,47 of whom had perioperative ischaemic complications,340 patients were included in the training cohort and perioperative ischaemic complications occurred in 31 patients.The LASSO regression analysis combined with multivariate logistic regression analysis demonstrated that hypertension,Fisher grade,A1 conformation,use of stent-assisted coiling(SAC),and aneurysm orientation were independent risk factors for perioperative ischaemic complications(P < 0.05).Then we developed a nomogram to construct a predictive model of perioperative ischaemic complications.We further validated this nomogram by external validation cohort and demonstrated an excellent diagnostic performance and calibration accuracy.Besides,the decision curve analysis confirmed the clinical utility of the nomogram.Conclusions: A history of hypertension,high preoperative Fisher grade,complete A1 conformation,use of SAC,and aneurysm orientation(pointing upwards)are risk factors for perioperative ischaemic complications for ruptured ACo AAs.This novel nomogram might serve as a potential early warning sign of perioperative ischaemic complications for ruptured ACo AAs.Part Ⅱ Analysis of risk factors and construction of predictive models for Intraprocedural rupture of endovascular treatment in ruptured anterior communicating aneurysmsObjective: To investigate the potential risk factors and possible mechanisms of Intraprocedural rupture(IPR)in patients with anterior communicating artery aneurysms(ACo AAs),and to construct a simple and effective intraprocedural rupture risk prediction model to validate the accuracy and explore the application value of the model,so as to provide a theoretical basis for reducing the risk of intraprocedural rupture risk and improving the prognosis of these patients.Methods: The general clinical,status on admission and morphological data,operation schemes,and treatment outcomes of patients with ruptured ACo AAs treated with EVT in the First Affiliated Hospital of Dalian Medical University from January 2010 to January 2021 were retrospectively analyzed.The independent variables were first screened using LASSO regression,followed by multivariate logistic regression analysis to identify intraprocedural rupture risk factors and build a risk prediction model.A Bootstrap sampling method was used to internally validate the model after 1000 replicate samples of the data.The discrimination ability,calibration accuracy and clinical utility of the established intraprocedural rupture risk prediction model were evaluated and verified based on the receiver operating characteristic curves,calibration curves and decision curve analysis.The possible mechanisms for the risk of intraoperative rupture events in these patients are then exploredResults: A total of 426 patients were eventually collected,of which a total of 19 patients developed intraprocedural rupture,an incidence of 4.5%.The LASSO regression analysis combined with multivariate logistic regression analysis demonstrated that the diameter of the aneurysm,the use of stents and flow angle were risk factors for the occurrence of intraprocedural rupture(P<0.05).Then we developed a nomogram to construct a predictive model of intraprocedural rupture.We further validated this nomogram and demonstrated an excellent diagnostic performance and calibration accuracy.Besides,the decision curve analysis confirmed the clinical utility of the nomogram.Conclusions: A smaller aneurysm diameter,use of stent assistance coiling and flow angles<90°are risk factors for intraprocedural rupture in EVT of ruptured ACo AAs.This novel nomogram might serve as a potential early warning sign of intraprocedural rupture for ruptured ACo AAs.Part Ⅲ Safety and efficacy of stent-assisted versus coiling alone in the treatment of ruptured anterior communicating aneurysmsObjective: To compare the safety,efficacy,and prognosis of stent-assisted coiling(SAC)vs.coiling alone(CA)in the treatment of ruptured anterior communicating artery aneurysms(ACo AAs).Informing clinical treatment decisions for patients with ruptured ACo AAs.Methods: The clinical and follow-up data of ruptured ACo AAs treated with endovascular treatment in the First Affiliated Hospital of Dalian Medical University from January 2010 to January 2021 were retrospectively collected.Patients were divided into a SAC group and a CA group based on whether stents were used,after which the two groups were matched for propensity scores.The general clinical data,embolization effect,perioperative complications,clinical and follow-up results after matching were compared.Results: Patients who were lost to follow-up and those with incomplete data were excluded,and a total of 358 patients were finally included.Patients were divided into the SAC group(127patients)and the CA group(231 patients)according to whether stent-assisted coiling was used intraoperatively.A comparison of the data from the two groups showed that the proportion of patients with hypertension,aneurysm size,aneurysm neck width,AR and SR values were significantly higher in the SAC group than in the CA group.After propensity score matching,110 patients were included in each group.Patients in the SAC group were significantly more likely to have intraprocedural rupture(6.4% vs 0%,P=0.002)than those in the CA group,while the rate of immediate postoperative complete embolization was significantly less than in the CA group(59.1% vs 75.5%,P=0.01).There were no significant differences between the two groups in the incidence of perioperative ischemic complications,mortality,poor prognosis at discharge or follow-up,mid-term complete occlusion rate and recurrence rate.Conclusion: The use of stent-assisted techniques for the treatment of ruptured ACo AAs did not increase the risk of perioperative ischaemic complications or the probability of poor prognosis,but it need to be alert to the high risk of intraprocedural rupture that it may cause.Although immediate postoperative angiography showed a lower rate of dense embolization in the SAC group.However,there was no difference in aneurysm cure and recurrence rates between the two groups,indicating that SAC treatment of ruptured ACo AAs is safe and feasible and has a reliable mid-term cure rate. |
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